How Kerala’s Poor Tribals Are Being Branded As 'Mentally Ill'

Paternalistic governance of mental health practices and advocacy fail to locate mental health problems in the broader spectrum of personal, social, political, and economic lives. 

Already wrestling with a range of dilemmas, Kerala, India’s most "developed" state has been witnessing unacceptable levels of violence and a polarised public discourse in recent times. The killing of a ‘mentally ill’ tribal man, Madhu, in Attappady in Palakkad by tying him up and circulating images of this on social media has been the most recent incident of violence, highlighting the Kerala paradox. The 30-year-old was hunted down by more than 15 assailants from his cave in interior reserved forests in connivance with the forest officials, reports indicate (Hindu 2018). Madhu’s hands were tied with his own clothes and he was severely assaulted by a mob in full public view for allegedly stealing a small quantity of groceries from a shop. Selfies were taken during the assault and shared with the public. He succumbed to brain haemorrhage and broken ribs in the police jeep. Instances of custodial deaths, vigilante attacks, and violence against marginalised groups, such as migrant labourers and sexual minorities have become frequent, unsettling the official narrative about the Kerala model of inclusive development.

In 2017, a 24-year-old man died after being attacked for being with his girlfriend on the beach and a transgender person was killed in Kochi. In March, a brutal assault occurred on a transgender person in Thiruvananthapuram who was accused of abducting children by “dressing up as a woman.” In 2017, a young Assamese migrant labourer, accused of theft, was tied to a tree and murdered by a mob in public view (Kashyap and Philip 2018). A month ago, another migrant labourer was brutally assaulted by a mob accusing him of abducting children. All of these allegations turned out to be false. Last month, a “mad” woman was dragged, thrashed with an iron rod and burnt by a group of women just because she happened to be a “nuisance” to these “normal” women (Devasia 2018; Anand 2018). Attacks, molestations and foisting of false cases of theft against sexual minorities, the mentally challenged, migrant labourers, and others living on the edges, and posting the visuals of torture  on social media have become increasingly common. The lynching of Madhu in Attapady is reported to be the fifth incident[1] of mob lynching in the past two months in Kerala, pointing to a rising regressive culture of "mobocracy" (Devasia 2018; Shaji 2018).

In most of these cases, law enforcers become law-breakers as the police are either directly involved in the violent acts or take no action against the perpetrators. Devasia (2018) notes that none of the accused were convicted in 335 cases registered in the state in connection with atrocities against the Scheduled Castes and Scheduled Tribes in the last two years.  

Does the series of such incidents where the perpetrators take pride in broadcasting their “heroic acts” through social media reflect the increasing acceptance of such violence? Are these blatant cruelties symptomatic of a hegemonic masculinity that is being celebrated? From where does the mob derive the courage to publicly display such blatant violation of laws? Finally, is the passivity of the state and the public rooted in heightened anxiety and insecurity around the perceived threat to the moral fabric of “civilised” Kerala in the context of the increasing presence of marginalised “second class citizens,” such as migrant workers and sexual minorities?

In the discourses on violence, perpetrators tend to stay in the margins. In each of these instances, the victim and their identity get the most media attention. In such cases, including the case of Madhu’s[2] lynching, the forest officials and the police were co-accused, but they have not been arrested yet.  If a tribal man can be lynched by a mob to the amusement of a public busy with  clicking selfies, one wonders about the extent of violence that goes on behind the camera. State discourses of development focus on the creation of de-addiction centres and rehabilitation homes to treat the “alcoholic” and the “mad” tribals, respectively, thereby reframing structural problems as individual psychiatric problems. In this way, the state colludes in excusing violence against marginalised identities by mostly focusing on compensating the victims with money and free treatment.

Marginalised Identities in the Development Discourse

Development has the potential to perpetrate silent violence by stripping someone of their sense of belonging and personhood through state and non-state interventions. Systematic expropriation of tribal lands has resulted in dispossession of land, loss of livelihood, internal displacement, exploitation and discrimination. Nissim Mannathukkaren (2018) aptly calls it “legal violence” against the Adivasis, accentuated by predatory capitalism and a developmental model without a human face.

The numbers of tribals who constituted 90.26% of Attappady’s population in 1951, plummeted  to a mere 34% by 2011, as they wrote off their lands to settle debts. When the rising infant mortality rate in Attappady gained attention, the government’s response was rather paternalistic as it opened community kitchens providing free food (an effort marred by allegations of widespread corruption). One of the main reasons why development has failed the tribals in Attapady and elsewhere is in the top-down approach where the tribals are not consulted or involved in development decisions related to their area (Philip 2018; Mannathukkaren 2018; Mathew 2018; Ameerudheen 2018). The lack of the right to self-determination for marginalised sections denies them their voice and robs them of their potency as vital stakeholders in their own “development.”

As far as sexual identities are concerned, Kerala has not been a safe haven for the marginalised. Sexual identities and their presence in the law and public discourse has been nearly absent until the Supreme Court’s judicial proclamation of equal protection of transgender persons before the law in 2014. In the very state that launched the first transgender policy in 2015 in response to the apex court’s ruling, sexual minorities have become easy targets of gruesome mob attacks, sometimes even in the hands of the police.[3] Kerala has witnessed an alarming 15 attacks against the transgender community including a murder  in the past eight months (Varier and Balan 2018; Ameerudheen 2018). For the media, reports about the issues of sexual minorities and alternative identities are often fuelled by the desire to sensationalise rather than empathise. Thus, Malayalam newspapers often simultaneously carry editorials supporting LGBT rights, even as other articles in the same newspapers use terms such as “unnatural sex” to refer to “homosexuality.”

Can Poverty be an ‘Individual Psychiatric Disorder’?

Following Madhu’s lynching, a celebrated Malayalam poet pointed out that if Madhu was indeed mentally ill, then he should have been treated and taken to a rehabilitation home. Reports indicate that several tribals in Attappady had become “psychiatric patients” with “diagnoses” of depression, alcohol dependence, and other “serious mental illnesses” as a result of serious social issues like dispossession of land, unemployment, malnutrition and discrimination.  In several articles, Madhu was described as “mentally ill” (Philip 2018; TNM Staff 2018; Ameerudheen 2018; PTI 2018; Shaji 2018).  This raises important questions about how complex social and economic issues are occluded by way of prescribing the label of “mental illness”. Public discourse brands Madhu as a “mentally ill” person, thereby denying him cognitive justice (Visvanathan 1997). Madhu, as a tribal youth who had to leave his job due to discrimination and consequent physical attacks at his workplace, and resorted to living in a cave inside a forest, wearing shabby clothes, and who allegedly stole rice from the shop to kill his hunger, was labelled "mad" by all quarters quite easily.

Community mental health professionals diagnose poverty and other social sufferings as individual psychiatric “disorders” to be treated with free medicines. The shabbily dressed tribal, the street-dweller and those with marginalised sexual identities all question the “normal,”  but find themselves slipping into the category of the “mentally ill.”

Mental illness thus becomes a means of social control.

Writing in a similar context, Sumant Badami (2014) lays bare the re-configuration of the complex social, political and economic conditions among the Paniya, an ex-slave tribal community in Wayanad, Kerala into individual medical problems. He also discusses how the mental health policy sidelines the changes in economic policy by promoting a specifically psychiatric analysis of suicide among the Paniyas (Badami 2010, 2014).

“Marginal” people at some geographical or social distance from “the centre”  are more likely to be misrepresented and misunderstood as being in need of more drugs, doctors and technology by health policymakers, especially when they look different or behave in “queer” ways (Ecks and Sax 2005). Here, poor tribals become psychiatric patients in need of free medicines when they deviate from prevailing cultural, social and political norms.

Unwanted Behaviours as Disorders

Our fieldwork in Kerala demonstrates that poverty and associated problems, gender role transgressions and “unwanted” behaviours tend to be labelled as “disorders”. I have been to tribal settlements serviced by community mental health programmes and seen that structural violence and social suffering among the tribals are being increasingly diagnosed as psychiatric diseases in Kerala. The following narrative from a psychiatric social worker (PSW) working in a community mental health programme demonstrates a reductionist practice of psychiatry where the focus remains on supplying free medicines and ensuring compliance.

“Food itself is a problem for them (tribals) due to extreme poverty. It is a big struggle for them. The intensity of psychosocial issues is more severe here. Many of them don’t know how to revise their ration card and hence don’t get the rice and other provisions (they are entitled to) and they starve. The tribals who were originally living inside the forests were relocated to colonies.  Even though we call them ‘children of forests’ they have no land at all in their possession. It is all grabbed by us (settlers). Forest Rights Act and all are not implemented and they can be cheated easily by offering some money. Many will be lured to come out saying they will be provided with home, land and toilet but after coming there they would have lost all the means of income and their skills won’t match any job available outside. The aim of our work is to find a key person to liaison with the patients to administer medicines. See, here we have associated with the Anganwadi worker. So this is how we enter inside (forests) and create trust. We provide syrup first (covertly); then if it doesn’t work we give injection (forcefully).”

Concluding from his ethnography based in Kolkata, Ecks (2005) meticulously shows the creation of “pharmaceutical citizenship” wherein health programmes construct people suffering from depression as being in a state of “marginality.”  Offering pharmacological treatment free of cost to the poor in distress comes to be viewed as a pathway to “development.” Yet, in jumping to conclusions about people’s mental health status, there is a severe failure in tapping the ecology of suffering (Bayetti et al 2015).

It is often the structure of society that adds to one's vulnerabilities.

Yet, the understanding of mental illness and psychiatry tends to be dominated by the biomedical discourse without paying attention to the social, political, and economic contexts of distress and suffering.

When I visited tribal homes as part of the community mental health programme in Kerala, the interaction of the mental health professionals with  tribal “patients” was indicative of the biomedical hegemony sidelining the latter's lived experiences. When a “patient” complained of tremors as being a side effect of the medicine, the psychiatric social worker (PSW) rejected his claim saying that those medicines did not cause tremors and insisted that he take medicines to prevent the occurrence of “disease.” The language of these mental health professionals is psycho-pathologically tuned to just elicit “symptoms” of “disorders.” With many tribals living in abject poverty and squalor, the mental health professionals interact briefly for four to five minutes with pointed questions to examine their “mental status” in order to fit them neatly into a specific diagnostic criteria. Typically, mental health professionals ask questions along the lines of whether there is any voice heard in their ears and whether they have any “thoughts.” A patient, when asked if his mind was peaceful, responded by saying that he is worried about getting food since he has been unemployed for almost four years. The mental health professional prescribed medicines to treat ‘bipolar disorder’ for this patient. 

In India, farmers’ suicides have been increasingly framed as psychiatric problems without regard to the defeatist agricultural policies of the government (Mills 2014).  Whether Madhu was mentally ill or not is not the question, the question is about the de-contextualised discourse surrounding his being identified as a “mentally ill” person. This has to do with the paternalistic governance of mental health practices and advocacy which fail to locate mental health problems in the broader spectrum of personal, social, political, and economic lives. This downplays the preconditions of poor mental health such as poverty, violence, breakdown of indigenous communities, disempowerment, human rights violations, power asymmetries, etc.

Development as Sanitisation and Homogenisation

There seems to be a dialectical tension between discrimination and integration in the context of increasing “development” in Kerala. For the modern Keralite, it seems, transgenders pose questions to “normative” families and the cave-dwelling tribal happens to be a threat to the “modern” "developed" state. Does development demand a kind of homogenisation of ways of life or does it demand integration of diverse ways of living?  Development needs to understand and recognise the diversities of human experiences. Respecting differences that are universal and imperative with respect to vision, ideas and philosophy is critical in enabling a peaceful, just, and sustainable society.

As B R Ambedkar presciently wrote:Man is born not for the development of the society alone but for the development of his self.” Development needs to be seen as an expansion of freedom by reimagining the subaltern as not static but dynamic with intra-group differences and varied needs. By being tolerant of multiple voices and enabling their amplification we can create a polyphony that represents the layered reality of the complex world that we share.

I owe my deep gratitude to Shubha Ranganathan who provided invaluable insights, comments and expertise that greatly assisted in writing this paper.

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